Basic Information
| Provider Information | |||||||||
| NPI: | 1043894504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATIONS FAMILY PRACTICE, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRIAD INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 DARRINGTON DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9843332741 | ||||||||
| FaxNumber: | 9193789114 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MACK RD STE B | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272051066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365100202 | ||||||||
| FaxNumber: | 3364934808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2021 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING/ENROLLMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 9843332741 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENERATIONS FAMILY PRACTICE, PA | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.